Probiotics and prebiotics: prospects for public health and nutritional recommendations

Probiotics and prebiotics are useful interventions for improving human health through direct or indirect effects on the colonizing microbiota. However, translation of these research findings into nutritional recommendations and public health policy endorsements has not been achieved in a manner consistent with the strength of the evidence. More progress has been made with clinical recommendations. Conclusions include that beneficial cultures, including probiotics and live cultures in fermented foods, can contribute towards the health of the general population; prebiotics, in part due to their function as a special type of soluble fiber, can contribute to the health of the general population; and a number of challenges must be addressed in order to fully realize probiotic and prebiotic benefits, including the need for greater awareness of the accumulated evidence on probiotics and prebiotics among policy makers, strategies to cope with regulatory roadblocks to research, and high-quality human trials that address outstanding research questions in the field.

Il/legitimate risks? Occupational health and safety and the public in Britain, c. 1960-2015

The last 20 years have seen the emergence of a popular climate of antipathy towards occupational health and safety regulation within the UK, particularly within the mainstream British media. The governance of health and safety has thus in recent years become an increasingly visible and contested public and political issue. The extent of this contestation, and its impact on the State’s governance of health and safety in the workplace and beyond, is explained and historicized within this chapter. Why has public rhetoric about health and safety apparently become so important in framing the ways in which the State could legitimately act in recent years? The chapter demonstrates how since 1960 the State remained a significant player – one among many, admittedly – and that while its roles in managing health and safety had long been bounded by a number of factors, a variable that emerged with particular saliency over the last 20 years has been a mediated notion of ‘public opinion’. This focus serves to remind us of the ways in which State action has at certain moments been pushed in particular directions by factors beyond formal mechanisms of rule.

Self-exclusion from health care in women at high risk for postpartum depression

Background A significant proportion of women who are vulnerable to postnatal depression refuse to engage in treatment programmes. Little is known about them, other than some general demographic characteristics. In particular, their access to health care and their own and their infants' health outcomes are uncharted. Methods We conducted a nested cohort case-control study, using data from computerized health systems, and general practitioner (GP) and maternity records, to identify the characteristics, health service contacts, and maternal and infant health outcomes for primiparous antenatal clinic attenders at high risk for postnatal depression who either refused (self-exclusion group) or else agreed (take-up group) to receive additional Health Visiting support in pregnancy and the first 2 months postpartum. Results Women excluding themselves from Health Visitor support were younger and less highly educated than women willing to take up the support. They were less likely to attend midwifery, GP and routine Health Visitor appointments, but were more likely to book in late and to attend accident and emergency department (A&E). Their infants had poorer outcome in terms of gestation, birthweight and breastfeeding. Differences between the groups still obtained when age and education were taken into account for midwifery contacts, A&E attendance and gestation;the difference in the initiation of breast feeding was attenuated, but not wholly explained, by age and education. Conclusion A subgroup of psychologically vulnerable childbearing women are at particular risk for poor access to health care and adverse infant outcome. Barriers to take-up of services need to be understood in order better to deliver care.

Starting well: Gender, care and health in the family context

In this article we present a critique of a series of public policy documents that aim at improvement in health for the general population, particularly families, but fail to recognize or appreciate the implications of gender for the everyday and the long-term experiences of family members. Drawing upon considerations of gender, families, health time and space and previous theoretical work (McKie et al, 2002), we propose the concept of healthscapes to aid the analysis and development of public policies. A healthscapes approach allows analysis of health policy within the diverse and multi-dimensional notions of time, space and gender that infuse the lifecourse. We assert that consideration of the gendered and generational project of caring particularly in relation to the (re)production of health, should involve a reflective inter-play between theory research and policy.

Improving the health forecasting alert system for cold weather and heat-waves in England: a proof-of-concept using temperature-mortality relationships

Objectives In this study a prototype of a new health forecasting alert system is developed, which is aligned to the approach used in the Met Office’s (MO) National Severe Weather Warning Service (NSWWS). This is in order to improve information available to responders in the health and social care system by linking temperatures more directly to risks of mortality, and developing a system more coherent with other weather alerts. The prototype is compared to the current system in the Cold Weather and Heatwave plans via a case-study approach to verify its potential advantages and shortcomings. Method The prototype health forecasting alert system introduces an “impact vs likelihood matrix” for the health impacts of hot and cold temperatures which is similar to those used operationally for other weather hazards as part of the NSWWS. The impact axis of this matrix is based on existing epidemiological evidence, which shows an increasing relative risk of death at extremes of outdoor temperature beyond a threshold which can be identified epidemiologically. The likelihood axis is based on a probability measure associated with the temperature forecast. The new method is tested for two case studies (one during summer 2013, one during winter 2013), and compared to the performance of the current alert system. Conclusions The prototype shows some clear improvements over the current alert system. It allows for a much greater degree of flexibility, provides more detailed regional information about the health risks associated with periods of extreme temperatures, and is more coherent with other weather alerts which may make it easier for front line responders to use. It will require validation and engagement with stakeholders before it can be considered for use.

Targeting medication non-adherence behavior in selected autoimmune diseases: a systematic approach to digital health program development

Background 29 autoimmune diseases, including Rheumatoid Arthritis, gout, Crohn’s Disease, and Systematic Lupus Erythematosus affect 7.6-9.4% of the population. While effective therapy is available, many patients do not follow treatment or use medications as directed. Digital health and Web 2.0 interventions have demonstrated much promise in increasing medication and treatment adherence, but to date many Internet tools have proven disappointing. In fact, most digital interventions continue to suffer from high attrition in patient populations, are burdensome for healthcare professionals, and have relatively short life spans. Objective Digital health tools have traditionally centered on the transformation of existing interventions (such as diaries, trackers, stage-based or cognitive behavioral therapy programs, coupons, or symptom checklists) to electronic format. Advanced digital interventions have also incorporated attributes of Web 2.0 such as social networking, text messaging, and the use of video. Despite these efforts, there has not been little measurable impact in non-adherence for illnesses that require medical interventions, and research must look to other strategies or development methodologies. As a first step in investigating the feasibility of developing such a tool, the objective of the current study is to systematically rate factors of non-adherence that have been reported in past research studies. Methods Grounded Theory, recognized as a rigorous method that facilitates the emergence of new themes through systematic analysis, data collection and coding, was used to analyze quantitative, qualitative and mixed method studies addressing the following autoimmune diseases: Rheumatoid Arthritis, gout, Crohn’s Disease, Systematic Lupus Erythematosus, and inflammatory bowel disease. Studies were only included if they contained primary data addressing the relationship with non-adherence. Results Out of the 27 studies, four non-modifiable and 11 modifiable risk factors were discovered. Over one third of articles identified the following risk factors as common contributors to medication non-adherence (percent of studies reporting): patients not understanding treatment (44%), side effects (41%), age (37%), dose regimen (33%), and perceived medication ineffectiveness (33%). An unanticipated finding that emerged was the need for risk stratification tools (81%) with patient-centric approaches (67%). Conclusions This study systematically identifies and categorizes medication non-adherence risk factors in select autoimmune diseases. Findings indicate that patients understanding of their disease and the role of medication are paramount. An unexpected finding was that the majority of research articles called for the creation of tailored, patient-centric interventions that dispel personal misconceptions about disease, pharmacotherapy, and how the body responds to treatment. To our knowledge, these interventions do not yet exist in digital format. Rather than adopting a systems level approach, digital health programs should focus on cohorts with heterogeneous needs, and develop tailored interventions based on individual non-adherence patterns.

Determinants of fruit and vegetable intake in England: a re-examination based on quantile regression

Objective To examine die sociodemographic determinants of fruit and vegetable (F&V) consumption in England and determine the differential effects of socioeconomic variables at various parts of the intake distribution, with a special focus on severely inadequate intakes Design Quantile regression, expressing F&V intake as a function of sociodemographic variables, is employed. Here, quantile regression flexibly allows variables such as ethnicity to exert effects on F&V intake that. vary depending oil existing levels of intake. Setting The 2003 Health survey of England. Subjects Data were from 11044 adult individuals. Results The influence of particular sociodemographic variables is found to vary significantly across the intake distribution We conclude that women consume more F&V than men, Asians and Hacks mole dian Whites, co-habiting individuals more than single-living ones Increased incomes and education also boost intake However, the key general finding of the present study is that the influence of most variables is relatively weak in the area of greatest concern, i e among those with the most inadequate intakes in any reference group. Conclusions. Our findings emphasise the importance of allowing the effects of socio-economic drivers to vary across the intake distribution The main finding, that variables which exert significant influence on F&V Intake at other parts Of the conditional distribution have a relatively weak influence at the lower tail, is cause for concern. It implies that in any defined group, those consuming the lease F&V are hard to influence using compaigns or policy levers.

Dairy farmers’ attitudes and intentions towards improving dairy cow foot health

Dairy cow foot health is a subject of concern because it is considered to be the most important welfare problem in dairy farming and causes economic losses for the farmer. In order to improve dairy cow foot health it is important to take into account the attitude and intention of dairy farmers. In our study the objective was to gain insight into the attitude and intention of dairy farmers to take action to improve dairy cow foot health and determine drivers and barriers to take action, using the Theory of Planned Behavior. Five hundred Dutch dairy farmers were selected randomly and were invited by email to fill in an online questionnaire. The questionnaire included questions about respondents’ intentions, attitudes, subjective norms and perceived behavioral control and was extended with questions about personal normative beliefs. With information from such a framework, solution strategies for the improvement of dairy cow foot health can be proposed. The results showed that almost 70% of the dairy farmers had an intention to take action to improve dairy cow foot health. Most important drivers seem to be the achievement of better foot health with cost-effective measures. Possible barriers to taking action were labor efficiency and a long interval between taking action and seeing an improvement in dairy cow foot health. The feed advisor and foot trimmer seemed to have most influence on intentions to take action to improve dairy cow foot health. Most farmers seemed to be satisfied with the foot health status at their farm, which probably weakens the intention for foot health improvement, especially compared to other issues which farmers experience as more urgent. Subclinical foot disorders (where cows are not visibly lame) were not valued as important with respect to animal welfare. Furthermore, 25% of the respondents did not believe cows could suffer pain. Animal welfare, especially the provision of good care for the cows, was valued as important but was not related to intention to improve dairy cow foot health. The cost-effectiveness of measures seemed to be more important. Providing more information on the effects of taking intervention measures might stimulate farmers to take action to achieve improvement in dairy cow foot health.